Provider Demographics
NPI:1437281524
Name:BERGIN, BETH A (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:A
Last Name:BERGIN
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2939 COUNTY ROAD 31
Mailing Address - Street 2:
Mailing Address - City:PAULDING
Mailing Address - State:MS
Mailing Address - Zip Code:39348-5154
Mailing Address - Country:US
Mailing Address - Phone:601-727-9471
Mailing Address - Fax:
Practice Address - Street 1:23 MASON ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-4437
Practice Address - Country:US
Practice Address - Phone:601-399-0539
Practice Address - Fax:601-399-1617
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS2352235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist